The age-old question of seniors’ sexuality

Consent in care a vital dialogue

Henry Rayhons hugs members of his family after being found not guilty of sexual abuse at the Hancock County Courthouse in Garner, Iowa, on Wednesday.

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This article was published 25/4/2015 (1399 days ago), so information in it may no longer be current.

Can a person with dementia consent to sex?

It’s a big, complicated question that has been top of mind for many following a high-profile criminal case in Iowa. On Wednesday, a jury found Henry Rayhons, 78, not guilty of sexually abusing his wife, Donna Rayhons, an Alzheimer’s patient who lived in a nursing home. He was accused of having sex with his wife after he was told by nursing home staff members that, due to her dementia, she was no longer able to give consent.

If there’s an upshot to this unprecedented case, it’s that it has opened a vital dialogue about consent and sexuality as it relates to an older population. Our society is pretty uncomfortable with the idea of seniors having sex. The notion sex is for the young and conventionally hot is a persistent one, and it might be preventing us from talking to our families about bigger issues surrounding sex as we age — such as what happens if and when we can’t express our needs and desires the way we used to.

Of course, older people do have sex. There is no age at which we cease to be sexual beings, no matter how much popular culture likes to play senior sexuality for laughs. To that end, discussions about intimacy and sexuality in a long-term care home setting aren’t new.

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Hey there, time traveller! This article was published 25/4/2015 (1399 days ago), so information in it may no longer be current.

Can a person with dementia consent to sex?

It’s a big, complicated question that has been top of mind for many following a high-profile criminal case in Iowa. On Wednesday, a jury found Henry Rayhons, 78, not guilty of sexually abusing his wife, Donna Rayhons, an Alzheimer’s patient who lived in a nursing home. He was accused of having sex with his wife after he was told by nursing home staff members that, due to her dementia, she was no longer able to give consent.

If there’s an upshot to this unprecedented case, it’s that it has opened a vital dialogue about consent and sexuality as it relates to an older population. Our society is pretty uncomfortable with the idea of seniors having sex. The notion sex is for the young and conventionally hot is a persistent one, and it might be preventing us from talking to our families about bigger issues surrounding sex as we age — such as what happens if and when we can’t express our needs and desires the way we used to.

Of course, older people do have sex. There is no age at which we cease to be sexual beings, no matter how much popular culture likes to play senior sexuality for laughs. To that end, discussions about intimacy and sexuality in a long-term care home setting aren’t new.

"The biggest principle I always bring forward is that intimacy and sexuality is something that people want and are from birth to death," says Norma Kirkby, program director at the Alzheimer Society of Manitoba. "The desire to be close to others, to have physical touch, doesn’t really diminish throughout our lifespan. The whole piece around sexuality takes different appearances or different levels of engagement at different times in people’s lives." She stresses both parties should feel a mutual benefit as well as a mutual sense of, "this is good for each of us." Like all healthy, consensual sexual encounters.

When the discussion shifts to consent and dementia, things get more complex. Under the Criminal Code of Canada, no consent has been obtained when someone is incapable of consenting to a sexual activity, or when the accused abuses a position of trust, power or authority to persuade someone to engage in a sexual activity. Someone cannot give consent on behalf of someone else, and someone can express — through words or conduct — a lack of agreement to engage in the sexual activity, or continuing to engage in the activity.

But the question of whether a person with dementia can consent to sex is hard to answer definitively. Kirkby points out determining a dementia patient’s capacity to make decisions can be difficult. Just because someone has dementia doesn’t necessarily mean they are incapacitated by it. People living with dementia very much live in the moment and, as such, consent needs to be an ongoing conversation. "It’s something that has to be worked through on a daily basis," Kirkby says, adding that as the disease progresses, one’s cognitive ability declines. "Some decisions they are able to respond to for a long, long time. Others, not so much. Just because it’s right today doesn’t mean it’s right six months from now."

As in any sexual encounter, consent can never be assumed. And a couple’s relationship status does not provide consent. Contrary to what some commenters on the Iowa case might believe, marital rape is real. It has been a crime in Canada since 1983.

Establishing a written policy around sexuality in long-term care centres is also challenging. How do you protect patients from harm while also allowing them the basic human right of sexual expression? Intimacy is important to one’s well-being; adopting, say, an extreme policy that forbids all physical contact among patients or between patients and their spouses won’t necessarily keep residents safer. In fact, it may do more harm than good.

Kirkby says it’s wise for long-term care facilities to recognize their residents have a need for intimacy and sexuality, as well as to reinforce in policy that sites need to work with families on solutions for each situation. "You can write policy that’s supposed to fit everyone, but it doesn’t," she says.

"It’s more about when someone wants privacy for intimacy, how are you going to accomplish it? And if there is a perception that things are abusive, how are you going to act?" In Manitoba, those living in care homes are offered protection from abuse under the Persons in Care Act.

Indeed, those on the front lines are entrusted with the care of their patients. While we can never know for sure what happened in that room, we can at least be sure employees at Donna Rayhons’ nursing home were doing their jobs.

jen.zoratti@freepress.mb.ca

Jen ZorattiColumnist

Jen Zoratti is a Winnipeg Free Press columnist and co-host of the paper's local culture podcast, Bury the Lede.

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